2014 ChooseWell Forums RSVP

1. Contact Information *This question is required.

First Name

Last Name

Title

Organization

Email Address

Phone Number

Community

2. Which forum(s) are you planning to attend? (Addresses for the forums will be available after completing this page) *This question is required.

Sexsmith, March 21
St. Albert, March 28
Lethbridge, March 31
Bowden, April 2

3. A limited number of travel subsidies are available to support the participation of ChooseWell communities for whom travel costs are a barrier to attendance. Subsidies will be at a rate of $0.40/km, to a maximum of $200. We strongly encourage carpooling and will facilitate connections among attendees from the same community as much as possible. Subsidy forms will be available at the forums. Are you interested in accessing this subsidy? *This question is required.

4. Please list the name of any guests you will be bringing to the forum(s). If you plan on bringing guests, but have not confirmed, please enter 'TBD' into the 'Guest Name' field

Guest Name 1
Guest Name 2
Guest Name 3
Guest Name 4

5. If you are planning on bringing more than 4 guests, please check the box below and we will contact you directly.

I am planning on bringing more than 4 guests.

6. Do you have any dietary restrictions? If yes, please specify. *This question is required.

Please enter an 'other' value for this selection.

2014 ChooseWell Forums RSVP

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